Joint mobilizations and manipulations Flashcards
Indications for a joint mobilization
- decreased passive movement of joint
- early capsular EF
- mechanical pain
Contraindications to joint mobilizations
- #
- neoplasm
- acute inflamm process
- apparent hypermobility or instability in direction of technique
- bone/joint infection
- spinal cord signs or symptoms
- spasm or bony end feel
Precautions for joint mobilizations
- impaired circulation or sensation
- osteoporosis or compromised health
- haemophiliacs
- poor skin condition
- open wounds
- discomfort in treatment position
- marked skeletal deformity
What do you base the grade of a mobilization on?
on palpation findings, PIVMs, PAVMs, quality of movement and EF *
What type of end feel do you never mobilize through
never mobilize through a spasm EF
Maitland grades?
Grades I-V
- I - small amplitude movement at beginning of range: with pain before resistance or at resistance (or use traction)
- II - large amplitude movement from beginning to middle of range (before resistance) usually into R1 when tissues start to tighten (when pain before resistance or at resistance)
- III - large amplitude movement from middle to end of available range (into resistance) R2 where limitation is usually due to a tight capsule (when you get resistance before pain)
- IV - small amplitude movement at end of available range into resistance (when you get resistance before pain or resistance and no pain)
- V - small amplitude high velocity movement at end of available range (when you have resistance and no pain)
Kaltenborn grading system
Sustained
i. small amplitude distraction
ii. distraction or glide to take up the slack
iii. distraction or glide to stretch the tissues
- cycle 6-10 second hold
Rx using mobilizations
- 3x 10 second bouts, checking in with patient
- then re-ax active movement, passive (PIVM or PAVM)
- then repeat 2 more times; always re-ax
- warn patient about treatment soreness and temporary after effects
Effects of a grade 1-2 mobilization
- neurophysiological (dec muscle tone, endorphin and enkaphaline release)
- mechanoreceptor stimulation (pain gaiting)
- vascular effect (joint nutrition)
- mechanical effect (mobilize collagen and neuromeningeal tissue, joint lubrication)
Effects of grade 3-4 mobilization
same as grade 1 and 2 plus: greater mechanical effect and enhanced joint lubrication, elongate shortened capsuloligamentous tissue
Effect of grade 5 mobilization
same as pervious grades but with greater neurophysiological and more mechanical effects, joint cavitation
Indications for joint manipulations
- to restore full ROM at end range of DF and PF when the progressive mobilizations are no longer effective (last 5 degrees)
- to gain last few degrees of DF and PF when a non-capsular limitation of motion is present *
What must you always suspect when doing a joint manipulation
ALWAYS SUSPECT AN UNDERLYING HYPERMOBILITY AND RE-AX STABILITY
Joint manipulation effects
- tearing of the scar tissue
- quick stretch to joint capsule
- stim of mechanoreceptors- neurophysiological effects
Contraindications to joint manipulations
- fracture
- joint instability in direction of manipulation
- inflammatory joint disease
- malignancy
- bone disease
- osteoporosis
- open wound or skin lesion in area
- poor circulation or sensory deficit in the area
- spasm or increased pain with test pull
- unsure of health or diagnosis
- patient doesn’t want to be manipulated (informed consent)
- patient is on anticoagulants
- haemophiliacs
- inability of patient to relax
- physio factors
